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Kumar et al. Computers and Modern Dentistry

Review Article

Modern Dentistry@Computerization Dot Com; An epigrammatic sketch of the

present scenario

Puneet Kumar1, Prince Kumar2

1Department of Public Health Dentistry, Prosthodontics, Shree Bankey Bihari Dental College,

Ghaziabad, India

Corresponding Author:

Puneet Kumar

Shree Bankey Bihari Dental College,

Ghaziabad, India

E mail: [email protected]

Received: 15 March, 2013

Revised: 10 April 2013

Accepted: 20 April, 2013

This article may be cited as: Kumar P, Kumar P. Modern Dentistry@Computerization Dot Com;

An epigrammatic sketch of the present scenario. J Adv Med Dent Scie Res 2013;1(1):17-28.

INTRODUCTION

Just a few years ago one does not know

much about computers. Computers aren't

just for sending bills they are multi media

education and communication centres. Some

of these ideas seem pretty extreme at first,

but once onyone understand why and how,

the progression is inevitable, and it will

transform the way we manage our dental

practices forever. Dental management

experience have led to a number of

ABSTRACT: Common use of computers and ready access to the internet is changing the way of the dentists all over the world in managing information and communication. Computer systems and internet have also helped improve the standard of dental practice by opening up a wide range of online professional information and resources. It facilitates communication among dental practitioners and with other health care providers. Computer software which could easily inter-relate photographic images and esthetic and cosmetic measurements would be a dynamic clinical tool and it is also beneficial in research to be conducted on cosmetic and esthetic canons. It is so common place that authors no longer give any details of the procedures. Thus a computer is becoming very popular in dentistry and it should not be less to say "The Future is coming and it will be Amazing”. Key words: Computers, dentistry, software, technology

17


unexpected opportunities, which are coming

together into a Comprehensive System to

help our profession learn about and use

technology. This includes Seminars, Users

Groups, Newsletters, Books and Articles,

Internet Groups, Consulting, Training,

Technology References, Hardware, Room

Design and more.1-4

All of this is designed to show regular

dentists how to use advanced technology and

sophisticated practice management

techniques in an effective manner. Training

and developing the people in the office,

including the dentist, to use advanced

technology effectively is at least as

important as the hardware and software

components. Dental office computer systems

with chair side terminals are not just

gimmicks using fancy toys but they will

increase efficiency, save money and quickly

pay for themselves.5-6

Computers in the treatment rooms, the

paperless office, digital images, CAD CAM,

information management and much more are

all coming to dentistry. And they are going

to come because they will make the way we

practice better. Just like the high-speed air

turbine hand piece changed dentistry

forever; new dental computer systems will

change how we practice forever. Some

dentists will hold back and fear change or

even resent it. Others will embrace new

technology and grow with it. However no

matter what your attitude is one thing is

certain:

DEVELOPMENT OF COMPUTERS

Computer technology has undergone a

significant change over a period of 4

decades. Prior to 1946, the only machines

available for data processing were desk

calculators and punch card system. In 1946

the world’s 1st electronic computer viz.

Electronic Numerical Integrator And

Calculator (ENIAC) was developed. This

has undergone various changes to become a

present day microcomputers which are far

more powerful and cost very little. The

advances in computer technology are usually

talked in terms of generations.7-8

The 1st generation computer started in 1945

contained 18,000 small bottle sized valves

which constituted its CPU. This machine did

not have facility to store and is complicated.

The 2nd generation computers found the way

for development with the invention of the

transistor in 1947. Such computers appear in

market in the early 60s. They are much

smaller and more reliable. The 3rd generation

computers followed the invention of

integrated circuit (IC) in 1959. They

appeared in the market in the 2nd half of the

60s. The 4th generation computers owe their

birth to the advent of the microprocessor in

18


1972. This device has enabled the

development of microcomputer, personal

computer and portable computers. The 5th

generation computers which are in

developing stage may use switch like high

electron mobility transistor and will be 50

times more faster than the present day

superfast machines.9-15

The computer can be a digital computer or it

can be an analogue computer. A digital

computer is one which operates essentially

by counting (using information, including

letters and symbols, in coded form). The

analogue computers operate by measuring

rather than counting. Digital computer

handles information as strings of binary

numbers that is zeroes and ones. Analogue

computer converts varying quantities such as

temperature and pressure into corresponding

electrical voltages and then performs

specified functions on the given signals.

Thus analogue computers are used for

certain specialised engineering and scientific

applications.16-19

HISTORICAL PERSPECTIVES OF

COMPUTERS IN DENTISTRY

The use of computers in dental education

and practice goes back to the mid 1960's

when they were used for specific and limited

tasks in the administration of dental schools

and large dental practices. An early

educational use was in the marking and

collating of multiple choice examinations in

some universities. The widespread

availability of both the Apple and PC

computers in the early 1980's changed the

emphasis and role of the computer and hence

the relationship dentists had with them. The

dentists became empowered at the expense

of the so called computer expert.

The hypothesis that dentists, in all disguises,

are "gadget mad" and were a natural group

to become computer enthusiasts will be

explored. This has resulted in dentistry being

in the forefront of the development of

computer uses in universities and dental

practice was ahead of medical practice in

both administrative and in office/surgery

functions. In recent years, however, the lead

has been eroded and there is now very little

innovation that is specifically dental and we

are using and adapting existing techniques,

hardware and software or sharing

developments in order to reduce escalating

costs. Dentistry in all its many facets is not

considered either different enough or a big

enough market to be separately developed.20-

25

THE COMPUTER SYSTEM

In general all computer systems can be

described as containing some kind of input

devices, the CPU and some kind of output

devices. The function of the input-output

19


devices is to get information into and out of

the CPU. The input devices translate the

characters into binary, understandable by the

CPU. The output devices translates them

back into the familiar character i.e. the

human readable forms. CPU has 3 segments

viz.

1. Internal storage

2. Control unit

3. Arithmetic logical unit

USES OF COMPUTERS IN

DENTISTRY

The practical application of computer

systems in clinical dental practice includes

office management, digital imaging,

radiography, and tale-consultation. The

emerging discipline of

dental informatics is derived from such

applications, and is sure to tremendously

affect the practice & development of

dentistry. A dental establishment can use

computer for a number of purposes:26-27

1. Administrative applications –

a. Patient appointments and recalls

b. Billing

c. Accounting

d. Correspondence

e. Inventory control and supply orders

f. Dental insurance claims

g. Document preparation & word

processing

20


h. Referral information

i. Missed appointments follow-up

2. Clinical applications –

a. Patient record storage & retrieval

b. Clinical diagnosis and treatment

planning

c. Computerized cephalometrics

d. CAD-CAM

e. Computer assisted densitometer image

analysis system

f. For special purposes like

computerized spirometers, blood

chemistry & gas analysers, ultrasound

scanners and CT scanners.

3. Other applications –

a. Controlling the circulation of books

and journals and their availability in

the library.

b. Creating a data base of survey

information.

c. Case presentation

d. Reviewing of literature

e. Entertainment & family use

EPIDEMIOLOGICAL DATA

MANAGEMENT BY COMPUTERS

The problem of analysis of dental

epidemiological data is the amount of data

which has to be collected to make any study

worthwhile. After collecting a data it has to

be looked under various ways and to be

compared them with the results of the

previous studies. If such a study is to be

undertaken by hand several months are

required to obtain the results and the analysis

is abandoned simply because of the time

factor. In the last few years, almost every

published reports of the dental

epidemiological work indicate that computer

facilities have been used for the analysis.

Preparation of epidemiological data for

the computer

One of the methods of entering the data is in

the form of punch cards but the data

collected in a dental survey cannot be

recorded by punch cards so it is necessary to

decide how the information should be

recorded. All the qualitative information

(male or female, good, fair or poor) to be

collected in a survey has to be coded in a

numerical or alphabetical characters

(male=0/m, female=1/f, good=g/1, fair=f/2,

poor=p/3). Quantitative data are already

numerical so do not need to be coded. In

edition to the coding it is necessary to decide

the position at which each item of

information is to be punched on to the card.

Some items will require only a single

column eg: sex, while some such as DMF

scores will require more than one. The total

number of columns designated for each item

is known as a field. It is necessary that each

field is always in the same position in every

card and care must be taken during the

preparation of the data.28-29 Ones the position

21


and code for each field have been

determined details should be fully

documented. The field length and the details

of the coding should be arranged to suit the

users requirements and the computer

programme accordingly.

The preparation of the data consists of the 3

phases – the collection, coding, & punching.

Dental data are normally recorded on a chart

in a diagrammatic form which has to be

coded and to ensure accuracy at the

punching stage this coding is usually

recorded on the second form. At the clinical

examination, the examiner calls out his

findings in code rather than in the usual

manner. After the collection of data they are

punched as previously described. The cards

are passed through a verifier in which a

similar sequence of events takes place to

ensure that the holes are in correct place.

Any errors detected are corrected before the

analysis begins. Using this method of

collecting data it is possible for a skilled

punch operator to prepare the data for

computation at about the same rate as it is

collected.

The dental data collected on punch card is

analysed in two steps:

1. The abstraction of the data according to the

various epidemiological indices.

2. The analysis of the results of the groups of

individuals using these indices.

The Abstract programmes are arranged so

that they may abstract details from the fill

mouth, or from any named quadrant or

quadrants, teeth or tooth groups. In this way

the programmes are very flexible and can be

used for partial as well as complete analysis.

The output of the analysis is usually in the

form of tables giving detailed results for

each group. When required the necessary

statistical test between groups can be

undertaken. It is also possible to produce bar

charts giving details of the DMF of each

group. Many analysers have reported that

this system was easy to use and many have

indicated that in the absence of the computer

they would not have considered starting their

surveys.

COMPUTERS IN AESTHETIC AND

COSMETIC DENTISTRY

It is essential to realize that facial and dental

aesthetics is not just components of parts of

skin, teeth, gums and lips in isolation that

are important, but it is a collection of

complex visual processes and interpretation

i.e. subconscious phenomenon. Professional

people such as surgeons, dentists, painters

and sculptors concentrate on individual

facial details like facial patterns,

configurations of facial components and

their contours.

22


COMPUTERISED RESTORATIVE

DENTISTRY

For more than 15 years, there are about

10,000 dental users of computer-aided

design/computer-aided manufacturing, or

CAD/CAM, systems, and about 7,000 of

those use the CEREC system. The concept

of computer-driven milling devices for

inlays, onlays, crowns and fixed prostheses

is excellent. Computerized systems for

accomplishing restorative dentistry have

made a significant impact on dentistry

worldwide. Of such systems, only the

CEREC system has remained on the market

for a period of years. Use of computerized

restorative dentistry in private offices is

growing, and other methods of using this

concept in dentistry are continuing to

improve.

HIGH TECH DENTISTRY

1. Digital Photography - Digital

photographs can be modified by using

readily available photograph editing

software (such as Adobe Photoshop, Adobe

Systems, San Jose, Calif.). When digital

photographs are modified to demonstrate

possible changes in patients’ appearance,

treatment plan acceptance is increased and

patients are educated more easily about

their treatment. This concept is one of the

most indispensable of all of the high-tech

choices.

2. Digital Radiography- The advantages of

immediate image observation, image

storage, image transfer by electronic means

and the ability to enhance images make

most users of digital radiography pleased

that they have changed from conventional

radiography to digital.

3.Intraoral television - an intraoral

television scanning of each patient’s mouth

should be accomplished by a staff member

at each recall appointment. The findings

should be recorded and the patient

education continued at each subsequent

recall appointment concerning the

previously observed needs. Intraoral

television is highly useful for patient

education, and most dentists use this

concept.

4.Orthodontic tooth movement -

conservative, planned movement of teeth,

as directed by computerized approximation

of movement required and effected by a

series of carefully planned trays, has

become popular. The most popular system,

Invisalign (Align Technology, Santa Clara,

Calif.), continues to grow in acceptance,

and other companies are now entering the

market.

5.Computerized shade selection - Several

automated shade determination devices are

available. Some shade selection devices are

relatively simple, while others require

several steps for colour determination.

23


Shade selection devices appear to be a

useful elective high-tech item.

TELE-DENTISTRY

Teledentistry is a relatively new field that

combines telecommunication technology and

dental care. Most dentists and dental

educators are unaware that teledentistry can

be used not only for increased access to

dental care, but also for advanced dental

education. Teledentistry in education can be

divided into two main categories: self-

instruction and interactive

videoconferencing. The interactive

videoconferencing method has had better

results because of its ability to provide

immediate feedback. Teledentistry can

extend care to underserved patient

populations, such as those in rural areas, at a

reasonable cost.

DENTAL INFORMATICS

Dental informatics is the application of

computer and information science to

improve dental practice, research, education

and management. A common misconception

is that informatics is the same as IT.

Informatics is focused primarily on research,

development and evaluation of information

models and computing applications.

A number of models, methods and

applications can be shared, transferred or

both between the two disciplines. For

instance, the National Library of Medicine’s,

or NLM’s, MEDLINE is the world’s largest

biomedical literature database and is equally

applicable to all health care disciplines. The

main goal of dental informatics is to improve

patient outcomes. Thus, the discipline must

support and improve diagnosis, treatment

and prevention of disease and traumatic

injury; relieve pain; and preserve and

improve oral health.

24


SELECTED COMPUTER APPLICATIONS IN CLINICAL CARE, EDUCATIONRCH.

AREA APPLICATION DESCRIPTION

Clinical Care

OralCDx

Digital Radiology

Tuned-aperture computed tomography

Decision support Systems

MEDLINE

CEREC Dental practice Management

Method for the screening of oral lesions that involves a brush biopsy and computerized analysis of the histologic slide, allows for screening of more patients for premalignant or malignant lesions earlier.

Equivalent to traditional film for many diagnostic and therapeutic tasks; advantages include reduced radiation exposure for patients and dental personnel, reduced development time, automation of quality assurance processes and the potential for immediate digital analysis.

Example of a three-dimensional imaging modality; applications include primary caries detection and assessing bone defects at implant sites.

Aid for dentists to make decisions about therapeutic approaches or complex or rarely encountered conditions; oral radiographic differential diagnosis, for instance, supports the diagnosis of radiographic lesions.

Database that makes a significant portion of the dental literature accessible to practitioners to help answer clinical questions.

Fabrication of machine-milled crowns and bridges during the course of an office visit. Automation of many routine tasks in a dental office, such as electronic claims submission, scheduling and financial management

Education Oral manifestations of HIV

Dental diagnosis and treatment

Simulations

Complete distance education programs

Computer-assisted learning package on the oral manifestations of human immunodeficiency virus of relevance to general dental practitioners.

Interactive program to provide students or practicing dentists an opportunity to develop and practice their critical-thinking skills for diagnosis and treatment.

Educational programs designed to closely approximate clinical situations for teaching, continuing education or performance evaluation

Integrated educational tracks, certificates or degrees offered at a distance

Research Data mining tools

Collaboratories Computerized data analysis

Analysis of large sets of data to generate new knowledge or findings.

Infrastructure to make it easier for large, geographically distributed research groups to work together Complex analyses of research data

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FUTURE OF COMPUTERS IN DENTAL

PUBLIC HEALTH

In the wider field of dental public health the

computer ought to be playing an increasingly

important role. Some local authorities have

used large main frame machines for their

medical records and for operating a recall

system for vaccinations and immunizations.

Such a system would form a hierarchical

system for the handling of patient records.

This could establish locally from the

epidemiological system and eventually the

machines central to an area might be linked,

forming a national network. If this were

achieved, then records could rapidly and easily

be passed from ane health authority to another

when patient moved. The fields of dental

epidemiology and dental public health have

expanded and developed quite considerably

over the last few years. If these subjects are to

continue to expand at a similar rate, then the

workers in the field cannot afford to ignore the

computer. They must be prepared to

understand these machines and keep abreast of

the technological developments, so that they

can be used to their maximum effect and

potential.

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Source of Support: Nil

Conflict of Interest: None declared

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Review Article Modern Dentistry@Computerization Dot Com ...jamdsr.com/pdf/moderndentistrycomputerization.pdf · cosmetic and esthetic canons. It is so common place that authors no